The Tectonic Plates of GME May Be Moving

Fitzhugh Mullan, MDMurdock Head Professor of Medicine and Health PolicyGeorge Washington University

Number of MD and DO Medical School Graduates from 1970 - 2013

Year

Nu

mb

er o

f G

rad

uat

es

0

5000

10000

15000

20000

25000

MD DO Total

Academic Year MD Graduates DO Graduates Total Graduates

1980-1981 15,632 1,151 16,783

1990-1991 15,427 1,534 16,961

2000-2001 15,796 2,510 18,306

2001-2002 15,676 2,536 18,212

2002-2003 15,531 2,607 18,138

2003-2004 15,829 2,713 18,542

2004-2005 15,760 2,756 18,516

2005-2006 15,927 2,708 18,635

2006-2007 16,140 3,000 19,140

2007-2008 16,168 3,364 19,532

2008-2009 16,467 3,588 20,055

2009-2010 16,836 3,631 20,467

2010-2011 17,362 4,159 21,521

2011-2012 17,343 4,458 21,801

2012-2013 18,156 4,726 22,882

Number of MD and DO Medical School Graduates from 1980 - 2013

Sources: AAMC and ACCOM

1st Year MD and DO Enrollment In2003 Compared With Projected 2017

Enrollment Figures

2003 2017 # and % Increase

MD 16,541 21,434 4,893 29.6% DO 3,308 6,675 3,367 101.8%

_______________________________________________ Combined 19,849 28,109 8,260 41.2%

Sources: AAMC Results of the 2012 Medical School Enrollment Survey, May 2013; AAMC Enrollment Data 2008 https://www.aamc.org/download/60740/data/enrollmentdata2008.pdfAACOM – Trends in Osteopathic Medical School Applicants, Enrollment and Graduates

Graduates and Projected Number of US MD and DO Graduates from 2008-2021

2008-2009

2009-2010

2010-2011

2011-2012

2012-2013

2013-2014*

2014-2015*

2015-2016*

2016-2017*

2017-2018**

2018-2019**

2019-2020**

2020-2021**

0

5000

10000

15000

20000

25000

30000

MD DO Total

Num

ber o

f Gra

du

ates

Year

| Extrapolated | | Projected |

Academic Graduation Year MD Graduates DO Graduates Total Graduates

2008-2009 16,467 3,588 20,055

2009-2010 16,836 3,631 20,467

2010-2011 17,362 4,159 21,521

2011-2012 17,343 4,458 21,801

2012-2013 18,156 4,726 22,882

2013-2014* 18,665 5,428 24,093

2014-2015* 19,230 5,788 25,018

2015-2016* 19,517 5,986 25,503

2016-2017* 20,055 6,449 26,504

2017-2018** 20,654 6271 26,925

2018-2019** 21,053 6,222 27,275

2019-2020** 21,255 6,179 27,434

2020-2021** 21,434 6,675 28,109

MD and DO Medical School Graduation Projections from 2008 - 2021

Sources: AAMC and ACCOM*Notes extrapolated data **Notes projected data

New Entrants into GME: Entrants into GME Without Prior GME 2010-2013

Sources: NCHWA analysis of data from AAMC and AACOM, April 2012; Number for 2011 is provisional; Number for 2013 is from NRMP and AOA

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 201320,000

21,000

22,000

23,000

24,000

25,000

26,000

27,000

28,000

29,000

30,000

25,105 25,15125,384 25,617 25,574

25,959 26,084 26,220

26,69227,198

27,489

28,45028,871

29,292

Entr

ants

Year

Projected US MD and DO Medical School Graduates (with 3% Attrition Rate) and 1st

Year Entrants into GME (2009-2021)

Year2014-2021 data are based on a 1% annual increase in entrants into GME

2009 2010 2011 2012 2013 2014* 2015* 2016* 2017* 2018** 2019** 2020** 2021**15,000

17,000

19,000

21,000

23,000

25,000

27,000

29,000

31,000

33,000

1st Year Entrants into GME US Medical School Graduates with 3% Attrition Rate

Match Year

1st Year Entrants into GME

US MD and DO Medical School

Graduates (3% Attrition Rate)

Difference

2009 27,198 20,055 7,143

2010 27,489 20,467 7,022

2011 28,450 21,521 6,929

2012 28,871 21,801 7,070

2013 29,292 22,882 6,410

2014* 29,585 23,370 6,215

2015* 29,881 24,267 5,613

2016* 30,180 24,738 5,442

2017* 30,481 25,709 4,772

2018** 30,786 26,117 4,669

2019** 31,094 26,457 4,637

2020** 31,405 26,611 4,794

2021** 31,719 27,266 4,453

Projected US MD and DO Medical School Graduates (with 3% Attrition Rate) and 1st Year Entrants into GME (2009-2021)

*Notes extrapolated data **Notes projected data 2014-2021 data are based on a 1% annual increase in entrants into GME

Teaching Health Centers and THCGME

White K. et al, The Ecology of Medical Care, NEJM, 1961

L. Green et al., The Ecology of Medical Care Revisited, NEJM, 2001

• GME History• Teaching in Health Centers• The ACA opportunity• Section 5508 of the ACA established the

Teaching Health Center Graduate Medical Education (THCGME) program

Teaching Health Centers

• The program is funded at $230 million from FY2011 to FY2015, a five year initiative.

• Administered by the Health Resources and Services Administration (HRSA).

• Under the jurisdiction of the Senate Health Education Labor and Pension (HELP) Committee, and the House Energy and Commerce Committee.

THCGME Program

• There are 44 THCs in 21 states across the country.– 3 states (Colorado, Florida and Tennessee) will be

added in the 2014 THC cohort.

• THCs are located in underserved communities in rural and inner city areas.

• Each year new THCs are added to the program. – In 2011 - 11 total THCs – In 2012 - 22 total THCs – In 2013 - 44 total THCs

Current THCs

THC Residency Numbers

2011 2012 2013

Number of THC Programs

11 22 44

PGY-1 THC Residents

44 154 273

# of residents per year in steady state

132 462 819

Specialty Number of THCsDental 2

Family Medicine 29

Internal Medicine 5

OB/GYN 2

Pediatrics 3

Psychiatry 3

THC Residency Specialties

THC Accreditation

THC Year ACGME AOA ACGME/AOA CODA N/A

2011 5 1 4 1 0

2012 0 9 1 1 0

2013 8 11 2 0 1

Total 13 21 7 2 1

• GW was awarded the Evaluation and Initial Assessment of HRSA Teaching Health Centers contract.

• This is a five year contract to better understand this model of community-based residency training, including an examination of the: – costs of training in THCs– contributions to the primary care workforce,

particularly in underserved communities.

THC Evaluation Project

• THC funding will end in 2015. • THC classes that began in July 2013 do not have

funding for the last 9 months of their training.• Future classes will have even less time funded.• THC programs may only be able provide partial

training to residents, and are hesitate to recruit or continue to expand their training programs.

Challenges for Teaching Health Centers

• On November 23, 2013 Senator Bernie Sanders (I-VT) introduced Senate Bill 1759, Teaching Health Center Reauthorization Act, which provides $800 million in funding to reauthorize the THCGME program for an additional five years.

• House staffers are examining a short-term funding patch. This patch will provide approximately $90 million to allow THCs to maintain full funding for all residents in their programs for academic year 2015-2016.

Options to Extend Funding for THCs

• The President’s FY 2015 Budget increases funding for primary care residency positions.

• THCGME program is not specifically sustained within any new targeted support for GME in the FY 2015 Budget.

FY 2015 President’s Budget

THCs are:

• Dedicated primary care education centers

• De-institutionalized medical training

• A means of increasing residency training without

“feeding the monster”

• Transformative and revolutionary: you pick!

Message for the Hill